The politics of visibility: who gets seen in digital health communication on Douyin
Article information
Abstract
China has increasingly positioned digital health communication as part of its national public health strategy, with short video platforms promoted as accessible and engaging channels for reaching diverse publics. As the Chinese precursor of TikTok, Douyin has developed distinctive governance mechanisms that shape the visibility and legitimacy of health content. This study examines how health-related information was framed, presented, and circulated on Douyin, and whose voices became visible under conditions of heightened urgency and public attention. Based on a quantitative content analysis of 1,074 most-liked COVID-19-related videos, the study analyses video sources, themes, presentation styles, emotional tones, featured characters, and engagement metrics. The findings show that news media, health professionals, and official actors were the most visible contributors, producing cohesive narratives aligned with state priorities. Ordinary users participated mainly through personalised and affective expressions, but largely reinforced rather than disrupted institutional framings. By using COVID-19 as a strategic case of a public health emergency, this study captures a moment when platform dynamics, state policy, professional authority, and public participation became especially visible. It foregrounds how health information visibility is produced, structured, and constrained under conditions of heightened urgency and public attention.
Introduction
During the COVID-19 pandemic, TikTok experienced a dramatic surge in global use, becoming a key site where people participated in dance challenges, memes, and other creative trends for fun and connection during months of isolation (Ostrovsky & Chen, 2020). Built around an algorithmically endless For U Page and visually engaging content cycles, TikTok’s combination of entertainment, participatory affordances, and attention-driven logics has foregrounded its growing potential in contemporary health communication (Sattora et al., 2024). Yet long before TikTok’s global explosion, its Chinese precursor Douyin – launched one year earlier by ByteDance in 2016 – had already been pioneering many of the platform design, features, and governance mechanisms that later defined TikTok (Kaye et al., 2021). For instance, during the pandemic, searching ‘COVID-19’ on Douyin displayed a pinned medical encyclopaedia entry from its built-in healthcare app, Xiaohe (X. Li, 2024). TikTok later adopted a similar approach by embedding Wikipedia entries in COVID-19 search results, suggesting that the study of Douyin can offer useful insights into platform-curated health information practices that may also appear in global short video platforms. Despite this, Douyin remains underexamined for its role in health communication in international scholarship, while research on TikTok has grown exponentially. This gap obscures how the visibility, expertise, and participation surrounding health are platformised in non-Western contexts, and how this platform logic may inform global practices of digital health communication.
As a Chinese platform, Douyin’s role in health communication cannot be understood without situating it within China’s broader policy vision. In recent years, China has increasingly framed digital health communication as a national public health strategy. The Healthy China 2030 plan designates health communication and education as its first major initiative, calling on health professionals and hospitals to actively use emerging media formats to improve public health literacy (The State Council, 2019). Medical institutions are instructed to establish dedicated health communication teams and operate official social media accounts, and health professionals are encouraged to integrate health education into their everyday practice by using social media platforms (Jiang & Jiang, 2021). Short videos are emphasised as an especially effective vehicle for reaching diverse publics due to their accessibility, shareability, and visual immediacy (National Health Commission, 2019).
At the same time, platform governance has structured the visibility and legitimacy of health content. Douyin enforces strict entry requirements for medical content creators: only licensed doctors at or above the attending level, affiliated with qualified medical institutions, are eligible for verified medical accounts and are permitted to share medical content (Douyin Health, 2023c). The commercial activities of health professionals on social media platforms have also been a regulatory concern. In 2022, the National Health Commission banned livestreamed product sales by health professionals, and Douyin reinforced this by restricting verified medical accounts from using private messaging, fan group features, and multi-channel network operations (Douyin Health, 2023a, 2023b).
Meanwhile, Douyin and TikTok’s parent company ByteDance has expanded aggressively into China’s healthcare sector. Since 2020, it has acquired multiple online medical platforms and private hospitals, consolidating them under the Xiaohe Health brand (Bloomberg, 2022). Xiaohe is now integrated directly into Douyin, offering in-app access to online medical consultations, a professional-authored medical encyclopaedia, and offline appointment bookings. Through this integration, Douyin has become not only a content platform but also an infrastructural gateway to healthcare services, aligning with state goals for accessible health information while simultaneously advancing ByteDance’s commercial strategy. Against this backdrop, health communication on Douyin emerges from the interplay between state policy, platform governance, and corporate interests. This makes Douyin a revealing site for analysing how short video platforms mediate public health discourse and shape whose voices are heard under conditions of both participatory affordances and regulatory constraint.
This study used COVID-19 as a case to investigate how health-related topics were framed, presented, and circulated on Douyin. Networked framing and participatory culture were used as theoretical lenses to understand how elite and non-elite actors participate in meaning making, and how platform logics and state guidance shape the politics of visibility and construct boundaries of public participation. By focusing on China’s most influential short video platform during a major public health crisis, this study not only extends research on digital health communication but also offers insights into the platformised visibility and the role of short video platforms in shaping public health discourse.
Networked Framing and Participatory Culture: The Politics of Visibility
Framing theory, developed by Goffman (1974), explains how individuals interpret reality through selective emphasis on particular aspects of an issue. In media studies, framing has been widely used to analyse how news organisations define problems, attribute causes, and suggest solutions (Entman, 1993). Framing theory assumes a largely top-down communication model, where elite actors function as gatekeepers who construct and circulate frames to the public. However, the rise of social media has disrupted this one-way model, creating spaces where meaning is negotiated in a many-to-many environment. Networked framing, as articulated by Meraz and Papacharissi (2013, 2016), extends framing theory to capture this shift. In networked environments, frames are no longer solely produced by elites but are co-constructed by multiple actors, including legacy media, institutions, influencers, ordinary users, and platform algorithms. This concept foregrounds the dynamic and iterative nature of framing, where bottom-up contributions – such as sharing, commenting, and hashtagging – can reinforce, reinterpret, or contest dominant narratives.
While in recent years, empirical research demonstrates that networked framing can facilitate the circulation of diverse perspectives but does not guarantee the visibility or influence of alternative voices. For example, in the European refugee crisis, Twitter (now X) hosted pluralistic discussions, yet dominant frames largely remained shaped by politicians, mainstream media, and large NGOs, leaving little space for ordinary users to gain prominence (Pöyhtäri et al., 2021; Siapera et al., 2018). In China, networked framing offers a lens for examining how state-led narratives interact with public discourse in a regulated digital environment. Studies of Weibo show that during pandemics government-affiliated media sustained cohesive frames centred on control and stability, while ordinary users promoted fragmented and emotion-laden frames (Zhao & Wang, 2023) and their reposting behaviours often reinforced official narratives strategically set by state-aligned accounts (Lu et al., 2024). These studies suggest that although networked environments and digital affordances technically broaden opportunities for participation, structural power imbalances may favour already prominent voices and the visibility and influence of frames may remain constrained by political control.
Like networked framing, participatory culture also describes a shift from traditional, top-down media production to a decentralised, collaborative model in which audiences actively create, share, and reinterpret media content. Originating from Jenkins' (1992) work on fan communities, the concept emphasised how fans reworked and expanded cultural texts, fostering creativity, collaboration, and social connection outside the boundaries of mainstream media control. Jenkins (2006) later broadened the concept beyond niche fandoms to encompass the wider participatory practices enabled by digital technologies, noting that the internet and social media lowered barriers to content creation and dissemination. However, Jenkins and colleagues (2013, 2016) argue that participatory culture is shaped not only by technological affordances. Digital platforms facilitate participation by enabling user-generated content and networked exchange, while they also constrain it through algorithmic curation, commercial imperatives, and governance structures. Participatory culture is therefore best understood as a dynamic interplay between empowerment and limitation, shaped by the cultural and political context in which participation unfolds.
In the health domain, participatory culture offers insights into how individuals and communities increasingly engage in the production and circulation of health knowledge. Vicari's (2022) work illustrates how participatory cultures enable patients and lay users to play active roles in defining health and illness. For instance, lay knowledge and patient experiences – such as those surrounding ‘long COVID’ – can move from informal discussions in patient networks to formal recognition in scientific and policy discourse. Such practices highlight the rise of lay expertise and proto-professionalism, where nonprofessionals access, curate, and mobilise medical information, bridging gaps between professional knowledge and lived experience (Vicari, 2022). While participatory culture fosters bottom-up health advocacy, patient-generated content, and peer-to-peer knowledge exchange, it also raises concerns about information accuracy, unequal access to participation, and the influence of platform governance on whose voices are heard (Avella, 2024). Thus, participatory culture offers the potential for more inclusive and interactive forms of health communication, but its realisation depends on the technological and regulatory environments shaping who can meaningfully participate and whose voices are amplified.
Taken together, networked framing and participatory culture offer a shared foundation for analysing how meaning-making unfolds in digital environments that are, in theory, decentralised and participatory but, in practice, structured by uneven power relations. Both concepts centre on the co-construction of narratives across heterogeneous actors, yet they also highlight the limits of participation and visibility – whether through structural hierarchies, algorithmic biases, or governance regimes. In this study, networked framing informs the analysis of who participates in constructing COVID-19-related health narratives and what kinds of frames become visible, while participatory culture informs the analysis of how these narratives are circulated, interacted with, and potentially amplified by platform users and platform itself. On Douyin, these dynamics are further complicated by the platform’s black-boxed and trend-driven recommendation system, which determines exposure in ways that are largely opaque to users. Visibility depends on algorithmic discoverability, participation in platform-native trends, and the production of visually engaging, high-tempo content (Vicari & Ditchfield, 2025). Ordinary users may gain sudden amplification through viral challenges, yet such visibility is contingent, precarious, and shaped by both platform and state regulatory constraints as well. Douyin’s stringent verification process decides who may speak authoritatively about medical topics, and state policy shapes which forms of participation are rendered legitimate and preferred. As a results, visibility is not merely the outcome of user activity but emerges from the interplay between user practices, platform mechanisms, and state policy. This context raises questions about how multiple actors participate in, construct, and circulate health-related frames on Douyin, and whose voices ultimately gain traction in shaping public understandings of COVID-19. To investigate these issues, this study asks the following research questions:
RQ1: Who were the primary actors shaping COVID-19 discourse on Douyin?
RQ2: How was COVID-19 framed, presented, and circulated on Douyin?
RQ3: In what ways did different actors vary in their framings of COVID-19 on Douyin?
Methods
Data Collection
COVID-19-related videos on Douyin were collected manually by searching 16 relevant keywords (Figure 1). Manual collection was chosen over automated scraping because search results for the same keyword varied within minutes on Douyin, even though they were ranked using the same criteria, by number of likes. Search results also varied between Douyin’s website and mobile app. While the results were not entirely different, some videos appeared and disappeared within minutes, and certain videos were exclusive to either the website or the mobile app. The reason behind these discrepancies remains unclear. Therefore, to ensure data integrity, this study manually searched the 16 keywords on both Douyin’s website (using ChromeOS version 110.0.5464.58) and mobile app (using an iPhone 12 with Douyin App version 24.1.0) at the same time each day.
Data collection procedure
To minimise the influence of algorithmic personalisation, a new Douyin account was created specifically for data collection. No prior browsing, liking, commenting, following, or sharing activity was conducted before the search process. Search results for each keyword were ranked by number of likes. To ensure visibility and manageability, only videos published before 1 February 2023 (the start date of data collection) with more than 10,000 likes were included. Metadata for each video (title, creator, hashtags, engagement metrics, length, publication date, URL) was recorded in an Excel spreadsheet, and videos were downloaded daily to prevent data loss.
Operationally, the search process continued until all qualifying videos appearing in the search results for each keyword had already been recorded in the spreadsheet. During each daily search, video titles in the search results were checked against the spreadsheet; a video was considered already collected if its title and creator could be matched with an existing entry. Data collection was thus conducted from 1 February to 21 April 2023.
After merging results from different keywords and removing duplicates, 1123 posts were obtained. 49 posts published in photo and text mode were excluded, leaving 1074 videos for analysis. Although the pandemic was an exceptional and time-limited event, it provides a moment of heightened visibility in which diverse actors participated in producing and disseminating health narratives. For this reason, COVID-19 serves as a strategic case for examining how health information is framed, circulated, and discussed on Douyin.
The dataset consisted solely of publicly available user-generated videos posted on Douyin. No private messages, non-public content, or restricted-access data were collected, and the researcher did not directly interact with users, contact creators, comment on videos, or otherwise intervene in platform activity. The study was approved by the University College Dublin Human Research Ethics Committee – Humanities as a low-risk study (Reference Number: HS-LR-23-12-Li-Siapera). Creator names, account identifiers, URLs, and downloaded videos were retained only for data management, deduplication, and coding purposes. Videos were analysed only through coded categories and were not individually reproduced. The analysis reports findings in aggregate form and does not include direct quotations, screenshots, account names, identifiable video stills, or other materials that could identify individual creators or users. Therefore, no additional consent for publication was required.
Data Analysis
Content analysis was conducted using a coding scheme adapted from previous studies (Y. Li et al., 2021; Zhu et al., 2020). The initial codebook was developed in June 2023 and refined through a pilot test of 150 videos, resulting in five dimensions: theme, source, emotion, character, and presentation type (Table 1). Each dimension had mutually exclusive categories. The coded categories were designed to connect the study’s theoretical concerns with empirical analysis. Source identifies which actors participated in framing health information; theme and emotion capture the substantive and affective frames through which COVID-19 was represented; presentation type and featured character show how these frames were made visible in short-video form. Together, these categories allowed the analysis to examine not only what health information was communicated, but also who participated in its production, how it was framed, and how it was made visible through platform-specific forms of presentation. To ensure reliability, one coder coded all videos, and a second coder coded 522 videos (48% of the dataset). Intercoder reliability was assessed using Krippendorff’s Alpha (α), yielding the following results: α=0.88 for theme, α=0.94 for source, α=0.85 for emotion, α=0.92 for character, and α=0.89 for presentation type.
Content analysis coding scheme
To answer RQ1 and RQ2, this study compared public engagement – measured by likes, comments, bookmarks, and forwards – across video sources, presentation types, themes, emotions, and characters. Visibility is understood here as a multidimensional concept rather than a single metric. At the platform level, visibility may refer to algorithmic exposure in recommendation feeds; at the search level, it may refer to the retrievability of content through keywords; at the audience level, it may refer to public engagement with content; and at the discursive level, it may refer to the capacity of content to shape wider public discussion. This study does not directly measure algorithmic exposure or discursive influence, as such data are not publicly available on Douyin. Instead, it operationalises visibility through publicly observable indicators of highly visible and engaged content. From the perspective of participatory culture, these metrics are used to capture different traces of user participation in the circulation of health information: likes are interpreted as an indirect indicator of visibility and audience attention rather than endorsement; comments as discursive activity; bookmarks as perceived informational value or future reference; and shares as redistributive reach. The analysis therefore focuses on how different actors and content types became visible within the publicly accessible and highly engaged layer of Douyin’s COVID-19-related health communication. To answer RQ3, presentation types, themes, emotions, characters, and video attributes were compared across sources. Video attributes included five compositional features and three video metrics (Table 2).
Video attributes
Results
Who were the primary actors shaping COVID-19 discourse on Douyin?
Table 3 presents the different sources that published the most-liked COVID-19 videos on Douyin. It shows that news media were the dominant source, contributing half of the dataset. Health professionals followed (24.02%), ahead of individuals (11.27%), officials (7.5%), and influencers (7.26%). This study did not distinguish between party media and commercial media because regardless of their level of marketisation, news organisations in China operate under the directives of the government.
Public engagement by video source
Kruskal-Wallis tests were conducted to examine whether public engagement differed significantly across video sources. The results showed significant differences in likes, χ2 (4) = 60.50, p<0.001; comments, χ2(4) = 10.31, p<0.05; bookmarks, χ2(4) = 115.09, p<0.001; and forwards, χ2(4) = 40.22, p<0.001. These results indicate that different types of actors did not receive equivalent levels of visibility and interaction on Douyin. News media videos attracted the highest likes, far surpassing all other categories. This indicates that professionally produced news content on COVID-19 gained significant traction on Douyin, likely due to its perceived credibility and broad reach. Officials, though contributing fewer videos, also attracted substantial likes, reinforcing their authoritative presence. Health professionals achieved similar level of likes but led in comments, bookmarks, and forwards. This indicates that audiences found information shared by health professionals more discussion-worthy and valuable for future reference. The high number of forwards implies that health professionals played a key role in disseminating crucial information, as users actively shared their videos with others. Individuals received relatively low engagement across all metrics.
The results reveal that COVID-19 discourse on Douyin was dominated by institutional sources. News media led in both volume and engagement, while health professionals played a distinctive role in fostering interaction and information sharing. Officials maintained a strong authoritative influence despite producing fewer videos. In contrast, influencers and everyday users had relatively limited visibility and engagement. These findings suggest that, despite Douyin allows anyone to share content, visibility and audience engagement were still largely concentrated among elite actors.
How was COVID-19 framed, presented, and circulated on Douyin?
The framing, presentation, and circulation of COVID-19 on Douyin were examined by analysing presentation formats, thematic focuses, emotional expressions, and featured characters in videos, as well as their engagement patterns.
Direct speech was the most common format (46.83%), followed by documentary style (28.21%). Kruskal-Wallis tests were conducted to examine whether public engagement differed across video presentation types. The results showed no significant difference in likes across presentation types, χ2(7) = 8.73, p=0.273. However, significant differences were found for comments, χ2(7) = 20.36, p<0.005; bookmarks, χ2(7) = 85.02, p<0.001; forwards, χ2(7) = 58.50, p<0.001. This suggests that presentation format was more strongly associated with interactive and redistributive forms of engagement than with visibility measured by likes. While direct speech dominated in volume, it also recorded relatively high median comments, bookmarks, and forwards (Table 4), indicating that spoken, explanation-based formats were not only common but also frequently saved and redistributed. Imaged-based videos achieved the highest average likes, bookmarks, and forwards, but their median values were more modest, suggesting that this category may have been influenced by a small number of highly viral videos. Creative performances such as dancing, singing, drawing also drew high average likes, but their median engagement levels were relatively low, emphasising the appeal of expressive content on Douyin.
Public engagement by video presentation type
Thematically, knowledge dissemination (34.54%) and pandemic updates (23.93%) together comprised over half the dataset (Table 5), reflecting a strong emphasis on informative content. Kruskal-Wallis tests were conducted to examine whether public engagement differed across video themes. The results showed significant differences in likes, χ2(9) = 39.63, p<0.001; comments, χ2(9) = 19.92, p<0.05; bookmarks, χ2(9) = 187.12, p<0.001; forwards, χ2(9) = 145.78, p<0.001. Knowledge-based videos were most forwarded, while government work report received the highest likes, showing strong audience interest in official communication. Entertainment content, though rare, achieved high likes and forwards, suggesting users were drawn to lighthearted content for amusement or emotional relief during the pandemic. Notably, conspiracy-themed videos drew the highest comments and relatively strong likes and forwards, demonstrating how controversial narratives stimulate interaction and spread.
Public engagement by video theme
Emotionally (Table 6), over one-third of videos were neutral or emotionless, and concern was the most common emotion among expressive content. Kruskal-Wallis tests were conducted to examine whether public engagement differed across emotional expressions. The results showed significant differences in likes, χ2(7) = 54.06, p<0.001; bookmarks, χ2(7) = 116.51, p<0.001; forwards, χ2(7) = 110.15, p<0.001. However, no significant difference was found for comments, χ2(7) = 11.20, p=0.13, suggesting that emotional expression was more closely associated with visibility, saving, and redistribution than with comment-based interaction. Nationalistic videos attracted the highest likes, indicating that content emphasising national pride or comparisons of China’s achievements with other countries resonated strongly with audiences. This result aligns with prior research (Zhang et al., 2022) suggesting that nationalistic narratives often attract high engagement in times of crisis, as they foster a collective identity and reinforce solidarity. Mobilisation, respect, and hope also achieved high engagement, while humorous content excelled in shares. Scepticism and conspiracy-related content generated high comment and forward counts, reinforcing their role in sparking debate. Although neutral or emotionless videos constitute the largest proportion, they received lower engagement across most metrics, emphasising the idea that emotional appeal plays a crucial role in attracting public interaction on short video platforms.
Public engagement by emotion
Regarding characters (Table 7), health professionals appeared most often and achieved high forwards and bookmarks, reaffirming their centrality in health communication during the pandemic outbreak. Kruskal-Wallis tests were conducted to examine whether public engagement differed across the main characters appearing in the videos. The results showed significant differences in likes, χ2(4) = 37.91, p<0.001; comments, χ2(4) = 14.14, p<0.05; bookmarks, χ2(4) = 67.73, p<0.001; forwards, χ2(4) = 31.59, p<0.001. Officials, though featured in fewer videos, received the highest likes and comments, reflecting public attention to official statements. However, audiences were less inclined to save or share their content compared to that of health professionals. Videos featuring everyday individuals were least engaged, indicating limited traction for non-institutional and non-expert sources.
Public engagement by characters
In sum, the findings demonstrate that Douyin’s COVID-19 content was largely framed through direct speech and documentary formats. Yet visually concise, creative, affectively charged presentations, and controversial content achieved strong resonance. While knowledge-focused videos dominated in volume and were widely shared, government work reports and updates received the most likes, suggesting that official messaging played a significant role in public discourse. Health professionals emerged as the most frequently featured figures, confirming their authoritative role in health communication during the pandemic. Government officials, though less visible, garnered significant attention. In contrast, general public saw lower representation and engagement, reinforcing the dominance of institutional and expert-driven narratives in shaping pandemic-related discourse on Douyin.
In what ways did different actors vary in their framing of COVID-19 on Douyin?
To understand how different actors framed COVID-19 on Douyin, the analysis compared presentation styles, thematic focus, emotional tones, and key video attributes across health professionals, officials, news media, influencers, and individuals. A chi-square test for independence indicated a significant association between video sources and presentation types, χ2(28, n=1074) = 405.67, p<0.001, with a large effect size (Cramer’s V=0.31). Health professionals and officials relied heavily on direct speech (Table 8), signalling a preference for formal communication. Officials also frequently incorporated documentary styles to pair spoken information with visual evidence. In contrast, news media, influencers, and individuals adopted more diverse formats. News media, while also frequently using documentary and direct speech, incorporated a mix of images, animations, and infographics. This diversity reflects their need to balance information dissemination and audience engagement through varied storytelling techniques. Individuals, in particular, applied more creative and visually engaging formats, making use of acting, animations, and even dance to present COVID-19 related messages.
Video presentation types by sources
A chi-square test revealed a significant association between videos sources and themes, χ2(36, n=1074) = 572.74, p<0.001, with a large effect size (V=0.37). Thematically, health professionals were the dominant contributors of knowledge-based videos (Table 9). Unlike other content creators who explored a broader range of themes, health professionals largely concentrated on publishing educational videos (209 out of 258). Officials had a relatively low presence with only 80 videos. However, their messages, particularly those categorised as work reports and updates, were largely circulated by news media. News media published the majority of work report videos (72 out of 89), and a large portion of updates (199 out of 257), suggesting that while official accounts may not be active in directly posting content, their information was widely amplified through journalistic channels.
Video themes by sources
Individuals, by contrast, contributed more personal experiences and expressed recognition to frontline workers, fostering emotional connections through lived experiences and collective appreciation. Notably, the prominence of videos recognising frontline workers aligns with the official call for promoting ‘Zheng Nengliang’ (translates as ‘positive energy’) on social media. This concept, frequently emphasised in Chinese official documents (e.g., The Supreme People’s Court, 2020), encourages uplifting narratives and has become a catchphrase for nationalism that reinforces unity, resilience, and collective solidarity (Chen et al., 2021). The resonance of this theme in user-generated content indicates that the individually produced posts gaining high visibility aften align with broader state-endorsed messaging on the platform.
A chi-square test indicated a significant association between video sources and emotions, χ2(28, n=1074) = 193.75, p<0.001, with a medium effect size (V=0.21). Emotionally, health professionals maintained a predominantly neutral stance, with occasional expressions of concern or hope (Table 10), reflecting an emphasis on scientific objectivity over emotional persuasion. Officials emphasise on expressing respect, reinforcing state-led discourse that encourages the expression of ‘positive energy’ and frames frontline workers as national heroes. This directive from the official appears to have influenced news media and user-generated content, as many of them also expressed respect in their videos. Such alignment suggests that the state’s emphasis and preference on certain kind of narratives had tangible impact on public discourse.
Emotions by sources
When it comes to the use of various video compositions (Table 11), health professionals relied overwhelmingly on spoken communication. This strong emphasis on spoken delivery was accompanied by especially low use of background music. This stands in stark contrast to other sources, all of whom relied much more heavily on music as an engaging element. Health professionals also made extensive use of subtitles and emphasised text to enhance accessibility. This indicates they strategically employed visual text to highlight key takeaways and reinforce essential messages, ensuring that critical information stood out amid the fast-paced nature of short video content.
Video compositions by sources
Video metrics also reflected distinct approaches (Table 12). Influencer videos were the longest, with an average length of 144.72 seconds, followed by videos published by individuals and health professionals. In contrast, news media videos were the shortest, averaging only 57.72 seconds. This suggests that news media used concise content to capture attention, likely to cater to fast-paced news consumption behaviours on short video platforms. By contrast, influencers, who often rely on intimacy with their followers, produced longer videos to provide more personal narratives. Health professionals, on the other hand, produced longer content likely because of the need to provide more detailed explanations. In terms of hashtag usage, individuals and influencers used more hashtags to improve discoverability, whereas news and official accounts relied less on them, as they draw visibility from institutional credibility. Title lengths were slightly longer for health professionals, individuals, and influencers, likely to clarify messages or attract clicks, while news and official titles remained concise.
Video metrics by sources
Overall, health professionals navigated Douyin with expertise-driven strategies. They favoured educational themes, neutral tones, and professional self-presentation, with long-form, text-rich videos. Influencers and individuals leaned toward engagement-maximising approaches, incorporating creative formats, personal narratives, and entertainment elements. News media and officials integrated nationalism and collective narratives into pandemic framing, with news outlets acting as crucial intermediaries for official messaging.
Discussion
Speaking but not framing: The invisible boundaries of public participation during the pandemic
The results of this study uncover the dominance and high-visibility of news media and health professionals in framing the COVID-19 on Douyin. While influencers and individual users also contributed to the pandemic-related conversation, their role was secondary in both volume and public engagement. Their content, largely aligned with the official-endorsed discourse and the state’s emphasis on expressing ‘positive energy’, served to humanise and diversify the primary frames set by elite actors rather than challenging or reshaping them. Compared to authoritative sources, influencers and individuals garnered significantly lower attention, highlighting the constraints on public participation in shaping health narratives especially during a health emergency. This also reflects the realities of a controlled media environment like China’s, where regulatory and black-box algorithmic mechanisms determine whose voices are amplified.
From the perspective of networked framing, digital platforms enable decentralised meaning-making, where both elites and non-elites engage in the framing of significant events. Everyday users can bring alternative voices or challenge dominant narratives through interactions from bottom-up processes. However, this study suggests that in China’s regulated media ecosystem, the networked framing process remains highly asymmetric. While social media afford individuals the technical means to participate in discourse, their role is predominantly reactive rather than proactive. Everyday users interact with dominant narratives rather than setting new frames themselves. Their participation is confined to reinforcing, embellishing, and extending the frames already established by authoritative sources, much like providing a humanised or emotionally resonant layer to the official discourse rather than fundamentally reshaping it.
The limited visibility of individual users also challenges idealised notions of participatory culture on short video platforms. Many studies have argued that digital media platforms widened the space for citizens to take part in defining health, but the findings of this study complicate such claims by showing that in China, where expert authority is strongly reinforced by state policy and platform governance, participatory affordances do not automatically lead to discursive influence. Even though Douyin lowers the barriers to participate – offering individuals the opportunity to gain rapid exposure by leveraging trends, algorithmic discoverability, and visually engaging content – these affordances do not necessarily translate into visibility and agenda-setting power. The case of COVID-19 discourse on Douyin illustrates that while influencers and individuals experimented with various strategies to enhance their visibility and engagement – such as using more hashtags, adopting creative formats, and incorporating entertainment-oriented elements – these efforts did not make their content dominant on the platforms. Instead, authoritative voices remained central and health professional retained dominance, while public participation was largely confined to the peripheries, operating within the state-approved discourse.
Ultimately, the discourse around the pandemic on Douyin reflects a hierarchical networked framing and participation, where elite actors – news media and health professionals, as well as officials behind them – occupy the central nodes of information dissemination, while influencers and individuals exist at the margins, contributing auxiliary narratives rather than shaping the core framing of the pandemic. This pattern is not entirely unique to Douyin, as health communication often privileges authoritative and professionally credentialed sources due to the perceived need for accuracy, expertise, and trust. However, in the Chinese context, this tendency is further reinforced by state-led health communication strategies, platform verification systems, and the regulated visibility of medical information. Existing studies of Weibo have similarly shown that government-affiliated media often sustain cohesive pandemic frames, while ordinary users’ participation tends to remain fragmented or to amplify state-aligned narratives (Zhao & Wang, 2023; Lu et al., 2024). This study extends these observations to Douyin, showing that similar hierarchies of visibility also operate on short video platforms, where participatory affordances coexist with platform governance and state-aligned structures of authority.
Behind the curtain: News media as the bridge between state messaging and public engagement
Although government-affiliated accounts maintained a relatively low direct presence on Douyin during the pandemic, their messages – particularly official work reports and pandemic-related updates – were widely circulated through news organisations and attracted substantial public attention. This pattern reflects China’s broader media governance model, where news organisations function as intermediaries between state messaging and public engagement (Ding & Zhang, 2010). Rather than directly engaging with audiences, government agencies relied on news media to disseminate their narratives, ensuring that official discourse remained central in public discussions.
The state’s preference for indirect communication through media intermediaries in the case of COVID-19 is not incidental but deeply rooted in China’s political communication system. Government agencies, constrained by their formal and authoritative image, typically adopt highly structured, bureaucratic, and serious communication styles that may struggle to captivate audiences on entertainment-driven platforms like Douyin. However, news media – often described as the throat and tongue of the government – play a role in translating these rigid state messages into more digestible and engaging content. By repackaging official discourse into dynamic, visually compelling formats, news organisations make state narratives more palatable for platform users while ensuring their wide circulation.
This strategic mediation is particularly relevant in the context of short video platforms like Douyin, where the attention economy rewards engaging and visually appealing content. News organisations adapted official information into more entertaining presentations, such as news cutouts, animations, posters, and even visually rich infographics. These formats allow official messaging to reach broader audiences who might otherwise disengage from highly formal government reports. News media videos were the shortest among all content creators, further reinforcing their efforts in aligning with the short video platforms’ fast-paced, bite-sized content consumption patterns. Unlike government agencies, which must maintain official authority, news media possess greater flexibility in their presentation styles, enabling them to straddle the line between state interests and audience engagement.
This finding stresses the symbiotic relationship between the state and news media in China’s digital landscape. While government institutions remain behind the curtain, news media serve as their public-facing voice, shaping the way official frames are communicated and received. This mediation process ensures that state narratives remain dominant while adapting to the evolving digital environment. The ability of news media to transform official content into highly engaging material reflects both a necessary adaptation to platform culture and a strategic mechanism to sustain state influence over public discourse.
Scrolling for knowledge: Short video platforms as vehicles for health communication
The prominence of knowledge-based videos and the dominant role of health professionals on Douyin during the pandemic emphasises the platform’s significance as a conduit for public health communication. While short video platforms like Douyin are primarily designed for entertainment, their ability to rapidly disseminate critical health information became particularly evident during the COVID-19 pandemic, when audiences actively sought credible and expert-backed guidance. The widespread presence of health professionals on the platform not only reinforced the importance of expert-driven communication but also highlighted how short video platforms can be used to serve vital educational purposes in times of crisis.
Unlike other types of content creators who often employ visually engaging or entertainment-orientated formats to maximise audience appeal, health professionals relied heavily on formal direct speech to maintain their authoritative position. Their videos rarely incorporated creative or interactive elements but still managed to achieve high levels of engagement, particularly in terms of comments, bookmarks, and forwards. This suggests that audiences did not merely consume expert-driven content passively but actively engaged with it – discussing it, saving it for future reference, and sharing it within their networks. The ability of Douyin to facilitate this level of interaction with educational content demonstrates how short video platforms, despite their entertainment-driven nature, can play a crucial role in the dissemination of scientific knowledge and health-related guidance.
However, the visibility of health professionals on Douyin was not merely a result of organic audience demand. It was also a product of both platform-level design and state intervention. Douyin has actively positioned itself as a platform for credible health information by implementing strict controls on who can publish medical content. This aligns with the broader state agenda of promoting digital health communication under the Healthy China 2030 initiative, which seeks to integrate health education into everyday digital experiences. By prioritising expert voices and regulating health-related discourse, both the platform and the government appear to reinforced the role of short video platforms as key infrastructure in China’s public health communication ecosystem. This institutionalised endorsement of expert-driven health messaging suggests that short video platforms are no longer passive hosts of user-generated content but have become integral players in shaping and structuring public knowledge in the digital age.
The evolving role of Douyin in health communication indicates that short video platforms are now embedded in the state’s broader efforts to strengthen digital governance over public health narratives. The case of Douyin during the pandemic also demonstrates that short video platforms can be powerful vehicles for health communication, reinforcing the growing convergence between social media infrastructures, expert knowledge dissemination, and state-led health governance in China.
Conclusion
The interplay between mainstream and non-elite actors on Douyin illustrates the negotiated nature of framing and visibility in China. While news media, health professionals, and officials dominated the framing of COVID-19 through cohesive and centralised narratives that emphasised pandemic updates, expert guidance, and government responses, ordinary users engaged through more emotionally driven and personalised content. This divergence indicates the structured boundaries of participation – where elite actors reinforce their authority through strategic adaptation to platform culture, while citizens interact with and personalise dominant narratives rather than fundamentally reshaping them. The findings suggest that on Douyin, participatory culture and networked framing do not necessarily empower users to challenge institutional power structures. Instead, they function within a regulated space where user engagement is encouraged but appears to remain shaped by institutional forces.
The findings also highlight how state directives and platform governance may shape patterns of prominence and visibility on Douyin. The presence of health professionals and their role in disseminating pandemic-related knowledge should not be understood as the outcome of public engagement alone, but rather in relation to platform mechanisms and state policies that emphasise professional authority and credible health information. This has important implications for digital health communication. Short video platforms should not be understood simply as neutral channels for distributing health information, but as governed information environments in which platform rules, verification systems, recommendation mechanisms, and state policy jointly shape the public visibility of health knowledge. For health professionals and public health institutions, this suggests that visibility increasingly depends not only on expertise and credibility, but also on the ability to adapt knowledge to platform-specific formats and modes of circulation. For platform governance, the findings point to the need to balance the amplification of credible health information with greater transparency over how health-related content is ranked, recommended, and made searchable during public health emergencies. As the Chinese government continues to emphasise the role of health professionals and short video platforms in governing health narratives under policies and initiatives such as Healthy China 2030, the institutionalisation of digital health communication extends beyond the crisis of COVID-19. COVID-19 thus provides an extreme but highly instructive case, offering a lens through which the dynamics of platform-based health communication can be observed under conditions of heightened urgency, uncertainty, and public attention.
Yet, the focus on COVID-19 also constitutes a limitation. As an acute and time-sensitive public health emergency, the pandemic created conditions that do not necessarily reflect everyday patterns of health communication on Douyin. Whether the patterns observed in this study persist in more routine, non-crisis contexts require further investigation. At the same time, several other limitations should also be acknowledged. First, because this study focuses on videos with more than 10,000 likes, the sample captures highly visible COVID-19-related health communication rather than Douyin’s COVID-19 discourse as a whole. The findings therefore speak to visibility and circulation among popular videos, rather than to all pandemic-related content on the platform. Second, although the manual search procedure was designed to improve data integrity, Douyin’s search results were unstable across time and between the website and mobile app. This instability means that the dataset reflects the videos retrievable through the study’s search procedure rather than a complete archive of all relevant content. Third, the study relies on publicly observable engagement metrics and does not have access to Douyin’s algorithmic recommendation data. It therefore cannot directly measure platform exposure or establish causal mechanisms explaining why some videos became more visible than others. Fourth, while comments were counted as indicators of discursive activity, the study did not analyse the content of comments, and therefore cannot determine how users interpreted, contested, or emotionally responded to the videos. Finally, likes, comments, bookmarks, and forwards cannot be treated as direct evidence of audience attitudes or endorsement. They are used here as observable traces of engagement, circulation, and informational value. Looking ahead, as Douyin continues to integrate new features such as AI health assistants and online consultations, future studies could further examine the long-term implications of platform-mediated health communication for expertise, public trust, and public understanding of health. Comparative research between Douyin and TikTok would also be valuable for assessing whether similar logics of visibility and governance can be observed in its international counterpart, and how these logics vary across different platform and regulatory contexts.
Ethical considerations
This research has been approved by the UCD Human Research Ethics Committee – Humanities (HREC-HS) as a low-risk study (Reference Number: HS-LR-23-12-Li-Siapera).
Data availability statement
All data generated or analyzed during this study are publicly available on Douyin. The codebook used for content analysis during the current study is available from the corresponding author on reasonable request.
Notes
Funding Information
This work was supported by the China Scholarship Council – University College Dublin Joint Scholarship (File No. 202108890010).
Conflict of Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.